General Practitioner, WA
Viral Hepatitis Elimination: Engaging marginalised populations
This session at the 2017 Australasian Viral Hepatitis Elimination Conference was a series of oral abstract presentations exploring a wide range of strategies in engaging marginalised populations, including persons incarcerated, people who inject drugs (PWID), Aboriginal and Torres Strait Islander populations/communities, and Culturally and Linguistically Diverse (CaLD) populations. Subsequently, various models-of-care adopted for each population in their respective studies and community settings.
Prof Andrew Lloyd provided an overview of the care for HCV affected people in prisons in Australia. Among the total of 230K living with chronic HCV in Australia, 65k of those are persons incarcerated, with many of this cohort being PWID and/or undertaking opioid substitution therapy (OST). Prof Lloyd spoke of the challenges of treatment adherence given the frequently movement of prisoners from one area of the prison to another (or movement to other facilities) and in some cases relatively short stays. The Surveillance and Treatment of Prisoners with Hepatitis C (STOP-C) study that he leads via the Kirby Institute throutout prisons in NSW is a nurse-led model of hepatitis care (NLMC) are appears to be very effective: a 95% of treated/assessed rate and currently 100 cases treated per month, despite barriers of pharmacy technology, challenges in drug procurement, etc. Future directions in this study include: establishing an Australian national prisons hepatitis network; to implement a practical strategies, such as, a one-stop shop for testing and treatment, and a 'treatment-as -prevention' approach aiming to eliminate hepatgitis C from the prison sector.
Dr Phillip Read of the Kirketon Road Centre (KRC) Sydney, presented a model-of-care for Alcohol and other Drugs (AoD) clients engaging with a huge diversity of care providers. There are numerous non-medical services ranging from government services to NGO and religious-organisations contributing to the complex care model for AOD clients, offering a range of services beyond clinical treatment, such as counselling. Currently, it is estimated that at least 25K PWID living with hepatitis C are still needed to be treated. The possible solution to engage PWID populations is to use an OST infrastructure. There is, however, a few challenge facing this strategy. For example: methamphetamine IV users have less medical contact, with only 10% of them are in care. Patients often had poor venous access, poor adherence and high risk for reinfections. Furthermore, many patient’s relationships with AoD services may not be always harmonious - with many experiencing stigma and discrimination in these settings. Nevertheless, many can be tackled in AoD-specialised setting. For example, HCV RNA testing using dried blood spot will be very practical for PWID with poor venous access. Overall, the HCV elimination campaign will be benefit from co-working with peers in the model of care for AOD.
Ms Carla Gorton and Ms Kathy Clark from Cairns Sexual Health Service in Queensland shared a personal experience of approaching and engaging with HCV in a sexual health setting/context. Their key messages were very strong: Respect, dignity, individualised care were required in providing care according to the individual’s need. Ms Gorton shared strategies for providing care for the sensitive group of people, including sexual worker and transgendered persons. Ms Kathy Clark provided contact, encouragement and transport to care. Personal engagement also helps to address issues such as shame and guilt and life priority. To reach people’s heart and mind, the networking of Cairns community members has facilitated a friendly access for hepatitis C patient to reach treatment without restriction.
Dr Malcolm McDonald is a consultant physician serving in three Indigenous health services in Far North Queensland. He shared in his presentation his plentiful experiences and great insight in approaching indigenous people in rural and remote communities. Each community has a unique history and different setting. Health Service should be in the community. It is encouraging to see that readily in-community care is available, including testing and treatment, even the in-community Fibroscan.
The end panel discussion of this session emphasised the need of continuing care and information should be transferred to primary carer, as well as, the barriers of providing continuing care for these populations.